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Geriatric junkies

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Half our elderly population take two or more drugs, causing side-effectsthat are mistaken for actual conditions and treated with still more drugs

Half our elderly population take two or more drugs, causing side-effects that are mistaken for actual conditions and treated with still more drugs. Here are the drug interactions to look out for, the steps to avoiding these common side-effects and effective alternative treatments

Q

Both my parents are quite elderly-in their early 80s now. They saw their GP a few years ago with what we all thought were just very minor problems, and they both came back with prescriptions for some medications. They have been taking those medications exactly as directed but, after a while, other health problems appeared. They went back to the GP and both of them were prescribed some additional drugs, which they have also dutifully taken as instructed. Then some further problems arose which they again discussed with the GP. To my astonishment, they were given yet more drugs to take, while none of the older ones were taken away. This very recently happened once more . . . and ended with still more drugs. Is this a case of drugs producing side-effects and more drugs given to quell those side-effects, which produce their own adverse reactions, necessitating yet more drugs?

T.D., PhD, Norwich

A

Since you haven't specified what drugs your parents were prescribed and are now taking, I am unable to respond specifically to your parents' problem(s). But if your elderly parents need to stay on orthodox drugs, here are some guidelines that you and they should bear in mind.

Polypharmacy-being prescribed more than one drug at a time-is common among the elderly because of the presumed presence of multiple disorders. Around half of the elderly take several prescribed or over-the-counter (OTC) drugs at the same time and often for long periods of time. As you suspected, many of the so-called diseases diagnosed arise from drug interactions that are perhaps being overlooked by both the GP and pharmacist. And adding more drugs only compounds the original problem.

Check out the table on the left for a summary of the most common drug interactions seen with the drugs usually prescribed to the elderly and how to manage them in older people.

The highest use of medications is among the institutionalized elderly. The average nursing-home patient is said to receive eight different drugs a day. In the case of the average mobile elderly person, it is seven different drugs a day (four on prescription and three OTC). This is not only due to the multiple illnesses older people are thought to have, but also because elderly patients are often consulting a number of doctors at the same time. In the case of your parents, though, it sounds as if they always consult the same GP.

There are yet other adverse drug reactions as well as drug-withdrawal syndromes, such as angina pectoris from suddenly stopping beta-blockers, hypertension due to stopping calcium-channel blockers and even withdrawal symptoms due to stopping addictive drugs like narcotics and benzodiazepine. There are also other, extraneous hazards like the increased risk of a fractured hip with benzodiazepine use.

But probably the most common contributory factor among the elderly is when medical practitioners inappropriately prescribe a drug to 'treat' an unrecognized drug effect-for example, giving a tricyclic antidepressant for depression due to a beta-blocker or a powerful tranquillizer for benzodiazepine-related agitation.

10- Return old medicines to the pharmacy or at least get them out of the house

11- Be aware of the risk of overdose in elderly patients known to have psychiatric conditions

12- Above all, recognize-and make sure the elderly patients know this too-that medicines can cause as well as alleviate illness.

Alternative ways to help your elderly parents

Osteopathic manipulative therapy(to help range of motion, respiratory and muscle energy problems) and particularly the craniosacral technique, including CV4 compression, are invaluable treatments for the elderly.1

Homeopathyoffers what I have found to be a reliable multisystemic remedy for the complaints of growing old-Acidum Sarcolacticum-which I use at a 12CH potency to good effect. Its clinical keynotes, revealed in experimental provings on healthy subjects, all point to problems of ageing and include multiple joint degeneration (such as arthritis), general asthenia (abnormal physical weakness or lack of energy), pruritus (itching), keratotic eczema (horny skin rash) and frequent nighttime urination.2

References

1

AAOJ, 2005; 18: 16-20

2

J Am Inst Homeopath, 1966; 159: 3-4

further reading

Ann Intern Med, 1991; 114: 956-66

Ann Pharmacother, 1989; 23: 847-54

N Engl J Med, 1991; 324: 1326-31

Geriatrics, 1989; 44: 57-61, 64

Prescribing for the elderly. British National Formulary. London: BMA, 2000; 39: 16-7

Harald Gaier, one of the UK's leading experts on alternative medicine and a registered naturopath, osteopath, homeopath and herbalist, practises at The Allergy and Nutrition Clinic, 22 Harley Street, London. Visit his website at www.drgaier.com.

If you have a question for our Medical Detective, write to us at the usual address or emailletters@wddty.co.uk.